Healing Combat Trauma

Quotable Quotes -- Dietrich Bonhoeffer on Suffering and Sorrow

Dietrich Bonhoeffer was a Christian theologian, author and martyr, who was executed in a German concentration camp during the Second World War. Among his powerful writings are these two short sentences about suffering and empathy/compassion in action:

"Some of us suffer a great deal from having our senses dulled in the face of all the sorrows which these war years have brought with them."

- and -

"It seems to me more important actually to share someone's distress than to use smooth words about it." -- Dietrich Bonhoeffer.

Quotable Quotes -- Chief Dan George on the Necessity of Love

It's not always easy to love a combat veteran with PTSD. Heck, it's not even easy to BE a combat veteran with PTSD and manage to love yourself, or those around you the way that you want to.

But part of healing is getting back in touch with how important love is, and even respecting its own form of therapeutic, healing power. Listen to these words from a very wise sage about just how important love is, in the natural order of things:

"Love is something you and I must have. We must have it because our spirit feeds upon it. We must have it because without it we become weak and faint. Without love our self-esteem weakens. Without it our courage fails. Without love we can no longer look out confidently at the world." -- Chief Dan George, Canadian First Nations chief, poet, author and Academy Award-winning actor.

Quotable Quotes -- Viktor Frankl on the Primacy of Experience

A sentiment that combat veterans everywhere might agree with, from the inimitable, invincible Viktor Frankl, World War II concentration camp survivor, in his book, "Man's Search for Meaning," translated from the German:

"What you have experienced, no power on earth can take from you."

Quotable Quotes -- George Grosz on How Long Combat Lasts

"I thought the war would never end. And perhaps it never did." -- Georg Grosz, artist/veteran, from his book "An Autobiography" (1955).

Grosz, a German who served during WWI, then fled Hitler and emigrated to the United States, where he continued his art, has some very striking paintings and drawings with subjects of war, explosions, suicide, and man's inhumanity to man. Fascinating stuff. If you want to learn more about Grosz' work, even an image search on Google (use "George Grosz" as the search string, and search within Google's images) will give you plenty to peruse of his talented work.

 

Healing Green: Therapeutic Gardening for Combat Vets with PTSD

The Financial Times (UK) just published a wonderful article, linked here, about therapeutic gardening for British combat veterans with PTSD.

The article, written by the FT's longtime gardening columnist, Robin Fox, makes the extraordinary claim, which we are bound to dispute on a lack of evidence, that "in nearly two-thirds of the American states, the state Veterans Administration runs designated 'horticultural therapy' programs." If so, that is the first we've heard about this!

Nevertheless, gardening for veterans and its near-relation, farming for veterans, both have their enthusiastic adherents.

In the UK, Anna Baker Creswell, featured in the article, sounds like she's doing tremendous work for veterans with her nonprofit, Gardening Leave, linked here. The FT article describes her work:

"Three years ago, Anna Baker Cresswell began her charity, Gardening Leave, in the belief that “horticultural therapy” might be a way out of soldiers’ PTSD. Now in her early forties, she is admirably forthright about her aims and ideas and “naturally bossy”, as she describes her impressive practicality. Since 2007, Gardening Leave has already helped 200 veterans with individually targeted work and social support. It has grown to employ nine salaried staff and to deploy an annual budget of £300,000, all of it fund-raised by Anna and her team."

Closer to home, here are the remarks of Dale, a Vietnam vet:

"I have been flower gardening for a few months now since I've moved to Southern California from Chicago. I was depressed in Chicago, as one can imagine with the long winters stuck indoors. I do feel better now that I'm doing my yardwork, planting seeds and flowers that I get from the very large nursery nearby. I have even been posting photos of my roses and others on Facebook. Not so depressed anymore; I don't have time for it!"

Having high hopes for gardening...are those realistic? Fortunately, it's not being suggested in lieu of other treatment -- that's important -- but in addition to, as a worthwhile endeavor for the veterans. There are many ways an experience can be "therapeutic," after all, if we broaden the definition of what that is, and horticultural therapy definitely has its benefits.

As Gardening Leave writes on their website, "Non-clinical interventions such as Gardening Leave and fishing which help to get veterans together again, also play a big part in helping to reduce the social isolation and exclusion which affect many veterans." YES! Absolutely...

A newspaper in New England talks briefly about horticultural therapy for veterans:

"Lorraine Brisson is president of the Northeast Horticultural Therapy Association, a nonprofit organization located in Massachusetts but with a membership that covers all of New England and New York. She also has worked as a horticultural therapist for 22 years at the Northampton Veterans Administration Medical Center in Leeds.

“I've had veterans leave my program who are totally different individuals from when they came in,” she says. “I had someone in a wheelchair a few years ago and we built a special raised bed for him and he had his own garden, and I'll tell you it was the most beautiful raised-bed vegetable garden I ever saw. Before that, he was not taking care of himself. That improved and he got himself a companion dog and starting taking the bus to work. I see a change in their whole attitude about themselves and what they can accomplish.”

Source: The Cape Cod Times, article linked here.

According to the American Horticultural Therapy Association ("AHTA") horticultural therapy has a long history in the United States, starting with one of the signers of the Declaration of Independence. From the AHTA website:

"Horticultural therapy (HT) is not only an emerging profession, it is a time-proven practice. The therapeutic benefits of peaceful garden environments have been understood since ancient times. In the 19th century, Dr. Benjamin Rush, a signer of the Declaration of Independence and considered to be the "Father of American Psychiatry," reported that garden settings held curative effects for people with mental illness.

 Rehabilitative care of hospitalized war veterans in the 1940’s and 1950’s greatly expanded the practice of HT. Today, HT is recognized as a practical and viable treatment with wide-ranging benefits for people in therapeutic, vocational, and wellness programs."

Here's another article talking about the benefits to veterans who experience gardening through a VA facility in Brockton, Massachusetts. For the veterans cited in the article, "horticultural therapy nurtures their spirit, and it helps them move forward." Here's the link.

And Kellie, a former Marine in the Midwest who served in Iraq, says her husband, also a Marine, enjoys his time in the garden. 

"My husband has an amazing green thumb. He enjoys his garden so much. It is very therapeutic for him."

Editor's note: For more about the American Horticultural Therapy Association, click here.

Quotable Quotes -- E.M. Forster on a Life in Transition

In a quote that rings true to those who have suffered something as life-changing as PTSD, after combat -- or for that matter, what happens in the life of the caregiver or loved one of the combat vet with PTSD:

"We must be willing to let go of

The life we have planned

So as to have the life

That is waiting for us." -- E.M. Forster, British novelist (1879 - 1970). 

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

 

The Sacred Brotherhood -- and Sisterhood -- of Those Who Understand

We read a few days ago Larry Heinemann's excellent quote about veterans after combat "carrying the darkness with us," linked here. And yesterday, in "War Creates Brothers," we learned about an historic gathering, a sacred ceremony of sorts, where Vietnam veterans like Heinemann met with Russian Afghansti veterans, at least a decade younger, and shared their stories with one another, bonding in the wet blood of brotherhood (and sisterhood, because it now applies to women veterans as well) from war. (That piece is linked here.) Now we synthesize the two together, with a quote from the article Heinemann wrote in 1989 in a national magazine, describing both the gathering mentioned above (lightly), and a much more extensive retelling of what the same Vietnam veterans' trip to Russia to meet with the Afghansti initially was like, a few months before.

Heinemann describes at great length the similarities and the bonds among the men that were formed, and tells the story of how the Russian veterans became involved in their own war in Afghanistan, leaving generally bruised and beaten "after nine years and 15,000 dead." Much of the article focuses on the stories of the Afghansti veterans they met in Russia, the grief of the devastated families of those who'd served, and the generalized indifference of the Russian government -- all of which he can compare, to one degree or another, to situations in our own country, after Vietnam. (As an aside, the bureaucracy of the VA seems to stand in for that of the Russian government in his analogy.)

As clearly as he paints the picture of the Russian veterans' suffering, and how it's mirrored in our own, one of the strongest descriptions he suggests is why the veterans on both sides of the conversation, separated by decades and culture, are nevertheless able to bond so strongly, through telling stories about their experiences, horrific and otherwise. This is the same principle we've been alluding to recently in the series about ritual, and the unburdening that can come from individual warriors when they meet up with one another, and have the safe "container" in which to share their suffering, confusion and grief. Here's Heinemann's remarkable quote:

"These stories and many others, came forward because the Afghansti finally had someone in their midst -- as we surely did not two decades ago [returning from Vietnam] -- who knew what they were talking about. We were fellow soldiers who could listen to the madness and know they were not mad; someone who could validate their worst blood-bath nightmares; someone who had an inkling of the brutality they had endured and inflicted; someone whom they could trust with stories about the deadest, darkest places in their hearts." -- Larry Heinemann.

Circling back around to Heinemann's earlier quote, mentioned a few days ago, we read in this article that it comes at the end of a longer declaration. As food for thought, I now include the full paragraph, in case it now adds fuller context, in light of the above.

"The Afghansti have caused a great many people a great deal of grief and have themselves suffered -- for a lie, let us not forget -- the same was we in the United States have caused much suffering in Southeast Asia, and have also suffered much in return, also for a lie. It was no small betrayal, no small lesson for a man to learn at the age of 19. Any soldier returning home must rediscover his humanity and establish a livable peace with the discovered, liberated, permanently dark places in his own heart --the darkness that is always with us."

"War Creates Brothers" -- U.S., Afghansti Vets Share Stories, Bond Together

A recent quote from the inimitable Dalai Lama: "To the extent that our experience of suffering reminds us of what everyone else also endures, it serves as a powerful inspiration to practice compassion and avoid causing others pain. And to the extent that suffering awakens our empathy and causes us to connect with others, it serves as the basis of compassion and love."

We've written on the site before about how combat vets "get" what other combat vets go through, and how they share that "wet bond of blood" brotherhood, here and here and many other places as well. (There's even something about it from the Civil War era, here; as well as Ernie Pyle, superstar war correspondent who "got" it, exemplifying it and communicating it from the boys on the front to the families back home, here.) We've started writing lately about "ritual" as a way that "primitive" societies, including sometimes our own, ceremonially bring back in the warrior from the war, embraced by his or her community. The work of Malidoma Somé is impressive as heck; but there are others shortly to speak on this as well, including other veterans who understand it and have lived it, and now want to share it with others.

But if we really want to envision the extent of what the Dalai Lama quote, above, embodies, let's take a look at a cross-cultural, multinational gathering of hard-core combat veterans from more than a decade ago. 

“War Creates Brothers”

U.S., Soviet vets share pasts on Peninsula

By Kevin Patterson

Peninsula Daily Times

Port Angeles – Larry Heinemann doesn’t know the word’s Russian spelling; Igor Zakharov doesn’t speak the English translation. But the word “brat,” which sounds like “brot,” instantly brings the two men together in a shoulder-shaking hug.

“My brat, my brother,” Heinemann explains.

There is much that should separate the two men. Heinemann is 45, an award-winning author, a Vietnam veteran.

Zakharov is 25. A machinist. An Afghansti – a Soviet military veteran who served in Afghanistan.

But they sat side-by-side on a rough cedar-plank bench, sharing American cigarettes and talking about coming home from war. Brothers. Soldiers. Grunts.

American “grunts,” G.I. slang for the everyday soldier, have been coming to this place west of the Elwa River for most of the 1980s. Counselor Bruce Webster has gained national prominence for his role in helping Vietnam veterans re-live their war experiences and confront memories that torment them.

Last weekend, Webster’s beachfront back yard ... became a bivouac for Vietnam vets and a handful of Russian veterans and counselors. It was more fruit from a budding relationship borne of war and government indifference to its warriors.

Heinemann and Zakharov met last December, when a group of Vietnam veterans toured the Soviet Union. Their mission was to make contact with Afghansti , while shunning official government representatives. [Heinemann wrote about his visit in a recent issue of a national magazine.]

“Our welcome by the Afghansti – perhaps 30 men in their early and middle 20s – was profuse, prolonged and astonishingly friendly: hand-shakes and warm smiles and immediate conversation,” Heinemann wrote.

Heinemann said the Vietnam vets saw a lot of ourselves in the young Russian veterans. It is a bond that transcends differences in language, culture and politics.

Afghanistan is often referred to as the Soviets’ Vietnam. It was a part-time war waged in a distant land for ill-defined reasons.

Soviet soldiers who fought in Afghanistan came home to discover that most people did not understand what the army was doing there. The government-controlled news media reported that troops in Afghanistan were there as advisers or to build public works.

Until 1985, soldiers killed in action were sent home in zinc coffins to be buried in secret, Heinemann said. Families often did not know how or where their sons died.

“They call it the false face of welcome,” Heinemann explained. “One man we met said his son might as well have been killed in a bar fight, for all he knew.”

The Vietnam veteran has faced an uphill struggle to win recognition of the scars left by the war. Post-traumatic stress disorder – PTSD – is the living monument to men who fought a senseless war against an enemy who played by different rules.

Heinemann knows about PTSD. His novel, “Paco's Story,” won the 1987 National Book Award. It was a fictional account of a Vietnam vet struggling with PTSD.

Help for veterans has been slow. Complaints about the U.S. government’s response to Vietnam vets are common. So are stories of Vietnam veterans wracked by the awful psychological after-effects of war. People’s understanding of what the war did to some of the soldiers is still evolving.

The Soviet veterans now grapple with some of the same problems, including a government indifference to their needs, Heinemann said. Their 10-year war ended in February, about 16 years after U.S. troops began pulling out of Vietnam.

Heinemann said Vietnam vets know some of what lies ahead for the Afghansti.

“I think that the Afghansti have a chance to save themselves a lot of grief, learning from our mistakes,” Heinemann said. “That’s why I wanted to bring them out here.”

Zakharov sat next to his American comrade, listening to a foreign language and struggling to answer a reporter’s questions.

He served two years in Afghanistan, the usual length of service for Soviet troops. He used a stick to draw 1982-1984, his time in Afghanistan, in the sand and sawdust of the outdoor conversation pit.

Heinemann said Zakharov was with an airborne unit. He was a minesweeper, whose job was to probe for landmines. His navy blue and white –striped undershirt, standard issue for airborne troops, mostly hid the scar he carries from a bullet wound to his left shoulder.

On his right wrist is a red band. The name of a U.S.  Army sergeant, killed in Vietnam, is inscribed there. It’s a memento of his visit to the Vietnam War Memorial in Washington, D.C.

“These are great guys,” Heinemann said. “They’re young and they’re tough and they’ve been through the mill.”

Reprinted with permission of the Peninsula Daily News.

Serving the Dragon: The Power of Ritual in Men's Healing after Grief and Trauma

Yesterday we introduced African tribal elder, Malidoma Somé, and a brief excerpt about using ritual for healing in the West. In today's excerpt, we have an excellent, longer interview done with Some, which goes into much greater detail about the richness and purpose of ritual. Big thanks to journalist,  poet and playwright Reid Baer who graciously gave us permission to use his interview in full. (A veteran and advocate well-acquainted with Some's work calls this the best interview he's seen, to date.)

It's fascinating to hear him discuss how simple and powerful ritual can be in helping selves and others to heal after grief and loss. Enjoy...

An interview with Malidoma Somé

In the Dagara tribe of West Africa, the name Malidoma means “He who makes friends with the stranger/enemy.” One wonders if the parents of Malidoma Patrice Some sensed that the name they gave their son would portend so much of his life.

Rising out of his spiritually rich, yet materially impoverished village in Dano, Burkina Faso, West Africa, Malidoma has become a world wide friend, teacher, public speaker, and author of three books: Of Water and The Spirit (his autobiography), The Healing Wisdom of Africa, and Ritual: Power Healing and Community. With the permission of the Dagara tribal elders, Malidoma is now sharing the indigenous wisdom of Africa with the West. This amazing man from humble origin has earned three masters degrees and two doctoral degrees – the first from the Sorbonne (in Paris) and the second from Brandeis University. In a remarkable way, Malidoma bridges cultures like no one else I know.

As Malidoma speaks, his voice carries the excitement, passion, and palpable spiritual quality that befit a gifted medicine man. Only the most accomplished Diviners, Gate Keepers, Shamans, and spiritual leaders are invited into a special “Elder” initiation in the Dagara tribe. Due to Malidoma's accomplishments and importance to his community, he became, at the age of 42, the youngest ever to become an Elder; not to mention the first with a full Western education. He possesses a unique understanding of how psychological disciplines and spiritual rituals can be utilized together in assisting individual personal growth.

“Ritual is the most functional means by which archetypal energies are dealt dealt with,” Malidoma began. “Indigenous people have been aware of that for eons. In the modern era, we focus too much on psychological counseling, he noted. There is a tendency for people to ‘linger endlessly’ in therapy for without receiving significant help. The “shadow” parts of our lives “keep coming back.” Malidoma believes that dealing with “the things we cannot escape” is best accomplished within the sacred space of ritual.

“Ritual facilitates and provides us with a unique channel to access higher power,” he said. “Certain issues don’t want to be resolved mechanistically. We don’t have to know how the power works; we just have to show up and let the higher forces deal with the issues. The trap we feel inside ourselves is removed once we enter into sacred space. The energies know how to push obstacles out.”

Malidoma said we tend to “project a godly power” onto human beings with a resulting dependency on others. It is in the nature of humans to project, he added. The question is, where do we direct the projections?

“Humans can not become god,” he intoned. “So we have to step away from that for a moment and remember the only place where we are authorized to project is in sacred space. If it is divine, then we are healed; if we project onto humans, we are deeply pushed into turmoil.”

Malidoma suggested that men should learn to trust their own ability to create sacred space, where they can be “vulnerable in a sacred fashion and allow themselves to be dismantled so that the rebuilding can produce a lasting result. The sacred space to initiate men is not necessarily a physical place, but an energetic place.

“It’s very hard to do this as an individual thing,” he said. “This kind of healing requires community -- men with men. The healing begins with the destabilization of a man’s energy. When he starts to feel unstable, it is best put in that place where other men or humans are. And eventually he will let go.”

Men usually fool themselves into “serving the big dragon,” Malidoma stated. However, with the help of other men observing from the outside, an initiate will begin to see his own dragon. The collapse of the traditional internal structure can then begin, and the “great opportunity of rebuilding the self occurs.”

“That idea is a hard-sell in this culture because men like to stay in control,” he continued. “Men have no room for a place of risk. In the business of healing, more often than not, we paint over the problems. This danger place that we are obligated to move into is a sacred danger because it endangers the very problems we deal with; and when it endangers them, we feel it endangers us too.”

Modern men identify too closely with their problems, he added, “and we become the problems, not the solutions.”

Malidoma said he believes men use the need for “safety as a condition of healing” as an excuse not to deal with the problem.

“We must endanger the problem by confronting it,” Malidoma instructed. “It is to be dug out of its hiding and exposed to the air. It cannot breathe oxygen. The light of day is lethal to it. That’s why the dragon tells us that we should be safe, because the dragon wants to be safe. We end up actually serving the very thing we want to be rid of.

The creative process is essential in coping with dragons, the Elder noted. “In talking about expression, we have to visualize it as more than speaking English,” he said. “Creativity includes non-verbal expression and the ability to use the entire body as a means of discourse.”

Malidoma said the dragon wants us to be introverted.

“Expression rips open the hidden cages and blind boxes, thereby releasing all the information hiding in there unbeknownst us to us and others,” he said. “To speak constantly into sacred space is to give oneself the opportunity of transcending … taking our lethal pain and diluting it into the ether.”

Malidoma experienced pain early in life when he was abducted from his tribe by Catholic priests and forced into a foreign Western culture. After a number of years, he escaped and returned home, where he was initiated into his indigenous community.

“Ritual or initiation provides a safe place for the soul and body to affirm life over death,” he declared, “to affirm continuity over discontinuity.”

The author said he has found “hope and dignity” through the daily practice of his tribe’s ancient rituals. He prays at the shrine of his ancestors, offering them water or libation, and asking the spirit of nature to walk with him throughout the day.

“After 30 some odd years, everywhere I am, I don’t feel alone,” he said. “I feel like a patrol of powerful spirits surround me. They give me a certain sense of reassurance and pride, so I can walk in the middle of adversity really knowing that in order for the adversity to get to me it will have to get through all these forces. It’s quite reassuring.”

Men don’t need a “sophisticated construction” to participate in ritual. Malidoma recommends we “look up at a tree” or “go to a creek and see the flow of water.”

“There may be some powerful genie dwelling in the water,” he said. “Talk to him like we talk to each other.”

The response may not be the loudest one we hear, but if we’re willing to listen carefully, we can hear the “big noise or echo” of nature tell us that “we’re right and to go on and walk proudly.”

In Malidoma’s village, the men are the spiritual leaders.

“Why? Because this is the kind of power, this is the responsibility every male is born with, and when assumed properly, it becomes authentic,” he said. “Women and children find themselves reassured by the men’s true power. It is when we pretend to assume the power that in fact we are derogatory and chaos is created. True male power is very healing for everybody. And so, if a man is not a self-centered control freak, he is one that will be serving, protecting, and holding the sacred space …. holding the space for everything and everybody to live.”

So, what keeps Western modern man from being the spiritual leaders in their own homes? “Men get caught up in the socio-economic nightmare of giving away most of their time in order to survive,” he answered. “We didn’t come into this world to give all our energy to stay alive, we came here to live. The biggest dragon is the one that tells us we have to work eight hours a day … and we end up being so tired that the very thing our soul is yearning for we don’t have time for. We have to tell each other to take time, and we need to hold hands with each other. Men have to be willing to come together to express what they feel to each other as the first step toward moving into that sacred space so they can heal enough to assume true responsibility in their own household. If we find a little moment to get together to pound on this problem, then we can go back to our respective homes and our partners and children … and they can see us shining in our true glory.”

“Community” is a strong recurring theme in much of Malidoma’s work. He defines it as a “bunch of people willing to come together in a circle in which they are conscious enough to invoke the sacred, the divine … to be with each other so they can express their authentic self to one another.”

“If men are willing to come together and be with each other, knowing they need supervision of the divine in order that their being together is not limited to talking about current events and drinking beer, then they have become a community.”

The community is strengthened by “invoking the sacred,” he added, but not by making themselves exclusive.

“Once we start attacking and excluding other communities then we have become a club,” Malidoma explained, “and then we have taken the ideas of society into our club, and the dragon prospers in us as a community.”

People sitting around and talking about the faults of other people are not a true community.

Malidoma expresses his own sense of community and his personal spiritual creative process this way: “I draw from bone energy and the memories that come from the bone. I allow myself to surrender to the higher forces with the clear intention that I want to be as clear and precise as possible. What comes out is something almost independent of me. There’s something quite militant in it, because when I express myself, and not after heavy duty preparation, I know that spirit is speaking through me. When I feel that intensity coming out, when I feel it, I know someone else will feel it. Every time I have attached my own emotion or capacity, I have to stand back and get out of my way so higher forces can speak. That has been transforming. I like to call that spirit. Spirit expresses itself in a way we cannot map, cannot tell ahead of time, and has its own plan – a plan not known to us. To know it, we have to surrender to it. It’s a risky thing. And risk-taking in the business of feeling, is worth doing. Check out www.malidoma.com.

© 2005 Reid Baer. Used with permission.

Quotable Quotes -- Half Full or Half Empty or Just...Right?

A wonderful quote from a longtime combat veteran from the other side of the pond, which expresses so well the "integration" we'd love to see for all veterans with PTSD. He writes:

"Sometimes my glass is half full... Sometimes my glass is half empty. I don't mind either view because when I sit back , have a think about stuff, I realize that my glass is really big. :-)"

Transpersonal Psychology, PTSD and Spirituality: A Therapeutic Approach

From a brochure about a now-past seminar given by Dr. Marius Koga, a look at the transpersonal therapeutic approach to PTSD and spirituality. I shared his comments with a friend, an Iraq veteran with PTSD, and she affirmed how completely his remarks fit with her impression of her situation. In her words: "He explained the exact reasons why I thought God hated me and was punishing me and why I turned to drugs. I always thought I was the only one who thought that way, and so it was nice to hear that from him."

In Dr. Koga's words:

"It is common for PTSD clients to seek religion and spirituality as part of their healing process. However, most psychotherapies are focused on the ego and personality constructs, while religious or spiritual considerations have been traditionally ignored. It is only in recent years that a therapeutic modality known as “transpersonal psychology “ has emerged which reintegrates psychology and the personality with the soul. The client is encouraged to actively maintain his/her individual self-concept in order to participate actively in his/her recovery. Concurrently, the client is guided to incorporate his/her individuality into the larger plane of the collective identity (including family, community, and religious and spiritual helping resources) to undergo personal transformation and growth. Our military especially, coming home from Afghanistan and Iraq, are seeking answers to painful questions about the gruesome realities of warfare, the value of personal faith, and the worth of human life itself. Many find that their faith in a God that is always available to respond to one’s personal tragedy can be utterly shattered. Soldiers and others who are unable to resolve such challenges find themselves lost in a spiritual flatland, which can take many nightmarish forms. They may feel abandoned by God, they reject or curse God, and they feel that God was powerless to help or even non-existent. They may even rationalize that their body mutilation, PTSD, or Traumatic Brain Injury was deserved punishment from God, or, in extreme, believe that their eternal damnation is God’s ultimate punishment. All too often, they feel they have no recourse but to numb their pain with drugs and alcohol. Their families suffer with them. By providing the opportunity for introspection about the meaning of trauma for the client’s life, transpersonal psychology helps soldiers, their families and friends, and others who have experienced PTSD and other traumatic events, to renegotiate the passive and silent state of the sick role and regain a sense of journeying, integrating, and healing." Marius Koga, MD, MPH, is a Diplomate of the American Academy of Experts in Traumatic Stress and an Associate Clinical Professor of Public Health at UC Davis School of Medicine. He is also a Professor at the Institute of Transpersonal Psychology in Palo Alto where he is directing a pilot center for trauma studies. Dr. Koga has developed courses in mental health and spirituality for Chapman University and has been the Course Director for Transcultural Mental Health and Spirituality at Tulane Medical School. A former political prisoner, torture survivor, and refugee from communist Romania, Dr. Koga’s interest is on PTSD in refugee populations and US military who are Afghan and Iraq war veterans. He has given numerous presentations, and workshops on spiritual dimensions of trauma in US and Europe.

Patrick Marius Koga, M.D., M.P.H.

Dr. Patrick Marius Koga is an Associate Clinical Professor of International Health at UCD School of Medicine, Dept. of Public Health and the President of the Veteran, Immigrant, & Trauma Institute of Sacramento (VIRTIS ). Dr. Koga was trained in Romania and at Tulane and his work in the past 20 years has focused on cultural and spiritual modulators of posttraumatic stress disorder due to armed conflict, complex emergencies, forced displacement, and immigration. His current international research work includes a cross-cultural psychometric evaluation of the reliability and validity of the Civilian Version of the Mississippi Scale for Combat-Related PTSD in the present Kyrgyz-Uzbek conflict in Kyrgyzstan, and a resilience study of the Iranian refugees in Turkey. At UC Davis Center for Healthcare Policy and Research, Dr. Koga is focused on needs assessments and epidemiological surveys of the psychosocial reintegration of OIF/OEF veterans with PTSD and of the disparity gap in mental health services available to Eastern European, Afghan, and Iranian refugees in the Greater Sacramento Metropolitan Area.

More about Dr. Koga, from his bio at the Institute of Transpersonal Psychology in Palo Alto, CA:

Patrick Marius Koga, MD, MPH

• MD, University of Timisoara, Faculty of Medicine, Romania, 1984. Specialization: Adult Psychiatry, 1988 
• MPH, International Health & Development, specialization in Cross-Cultural Mental Health & Medical Anthropology, Tulane School of Public Health & Tropical Medicine in New Orleans, Louisiana, 1999
• Board certified and Diplomate of American Academy of Experts in Traumatic Stress, 2006.

Marius is a Professor at the Institute of Transpersonal Psychology. A psychiatrist and a former political prisoner, torture survivor, and refugee from communist Romania, Marius’ professional interest focuses on the cultural, religious, and spiritual dimensions of PTSD in war refugees from Eastern Europe and the Middle East who have resettled in California. His spiritual path unfolds out of over two decades of practice of Advaita Vedanta, Zen Buddhism, martial arts (5th degree black belt in Karate-Do, 4th degree black belt in Judo and Jujutsu) and out of several years of monastic living as an initiated disciple of the Ramakrishna Order of India.

For the past ten years Marius has also been promoting cultural, religious, and spiritual competencies in medical student education in various capacities such as Dean of International Medicine & Development, Cambridge Overseas Medical Training Programme, Cambridge, UK, Course Director for Transcultural Mental Health and Spirituality at Tulane School of Medicine in New Orleans, and currently as an Associate Clinical Professor of International Health at the UC Davis School of Medicine. 

Marius believes that in an increasingly globalized world, ridden with disparities, conflicts, and violence, ITP has a unique opportunity to partner its expertise and leadership in transpersonal psychology with public health, medicine, government, policy makers, donors, educators, and factors of social change to reduce suffering and mental illness, and to promote individual and collective growth and well-being. 

Editor's note: For more on Dr. Koga's work with VIRTIS, which also focuses on veterans, click here.

From the Canadian Side of the Street: A Military Author's Take on Veterans Suffering from War and PTSD

One of the many blessings of the new media -- social media like Facebook -- are the interesting, talented people one meets within that. One such person is Bonnie Toews, a Canadian former journalist and novelist with a longtime background in writing about the military. I forwarded her an article from the Montreal Gazette last week about social workers quitting because of burnout in Canada, meaning that fewer will be available to serve returning veterans with PTSD, and this is what she wrote on her website in response:

Outrageous failure of government assistance to returning Afghanistan vets

"It is wonderful that we celebrate the lives and courage of fallen soldiers when they are repatriated to CFB Trenton and paraded down the Highway of Heroes, but the question that is never answered: who looks out for the returning vets? Especially those whose minds, bodies and spirits have been shattered on a continual rotation of tours through the past eight years.

It is disgusting and absolutely unacceptable to hear that Canada's Veterans Affairs is cutting back on social workers because WWI and WWII vets are dying off. 

Excuse me, but Canada has a whole new generation of vets who have served in Afghanistan for eight years. By next year it will be nine years. The war in Afghanistan has lasted longer than either world war in the 20th Century and soldiers have been repeatedly rotated through three and four tours because our forces aren't large enough to handle a deployment this long and this demanding. These vets and their families need help to mend their lives back together. 

Kevin Dougherty in Montreal's newspaper, The Gazette, writes that soldiers suffering from Post Traumatic Stress Disorder can wait up to four months before seeing a social worker, a necessary step to integrate them back into society and return them to the labor market. 

Why? Because federal social workers each have a caseload of 40 clients to their provincial counterparts, who carry a caseload of 20 clients each. There are not enough social workers to contend with the need, and under such strained resources, these caregivers burn out, depleting veterans' social services even further. 

People forget that soldiers returning home are not the only victims of the wars they've fought. So are their loved ones, families and friends. They need as much social assistance as the soldiers themselves. Those coming home are forever changed. They have experienced things the rest of us can't imagine. They carry this psychological burden for the rest of their lives. 

In 1994, in Rwanda, I was briefly introduced to that world of theirs. I was one of the few North American journalists covering the massive humanitarian effort following the genocide against the Tutsis and moderate Hutus in Rwanda. One peacekeeper after another told me what they saw, incomprehensible mass slaughter with no human respect whatsoever and they were forced to observe because the UN didn't give them the mandate or size of force to quell the madness. Soldiers trained to fight and defend forced to stand down. Can you imagine the helpless rage they experienced? Yet, when I came home, I faced the same apathy from friends, co-workers and the public as they did. My husband proudly explained that I had been in Rwanda and time and time again I was asked, "Did you go there on holiday?" 

People didn't even know what was going on, and were indifferent when I chose to explain. I, like so many soldiers, learned not to talk about it because no one really cared to listen. 

This time the public must get behind their vets and demand the social services they deserve and need. This is the most important tribute we can give our returning vets for the sacrifices they've made on behalf of our country."

 -- Bonnie Toews. A longtime journalist reporting for logistics and private security magazines and now a novelist, speaks out for the victims of genocide and war, from the peacekeepers and coalition forces trying to save suppressed peoples to the children and innocent civilians caught in the crossfire of opposing powers, ideologies and cultures. Current writing "Trilogy in Treason." Member of Military Writers Society of America, American Authors Association and ACFW. Her website is linked here.

Editor's note: Find us on Facebook, here; follow us on Twitter @HealingPTSD.

Veterans, PTSD and Suicide: The Overlooked Element of Contagion

This is an article I'd first started writing two years ago now. I did the research, and located the main, most often-cited study's principal investigator, long since retired, and asked him to confirm whether the trend is still true, though he first published it back in the 1970s. He affirmed that it was. What it is is an important and often-overlooked "connection" that will make more sense when we start describing it. It also fits into the category of things where the information is out there, but for some reason is also strangely ignored. Another instance was a few years ago, when the military kept saying, "We don't know what PTSD is tied to"; essentially, "we have no idea." Yet at the time, and this goes back several years now, I was able to read through the existing literature and learn, PTSD is tied to combat exposure. In other words, the more combat, the greater the chances of developing PTSD. And I wrote about it, here, at the time the military was saying, in essence, we don't know what it's linked to.

So it isn't that that wasn't known...it's that no one was paying attention to what was out there. (And these days, several  years later, they ARE admitting publicly that more exposure = greater chance of developing PTSD. But it does make me laugh a little bit to hear that now, thinking, we were talking about it here well before that was being said publicly. And not because of some strange prophetic abilities on our part; just from reading the available literature, and drawing what seemed like obvious conclusions.)

There's the old saying that "those who refuse to learn from history are condemned to repeat it." Well, much of what's known about PTSD has been known for decades now, with another fair part of the knowledge base has been increasing exponentially. I read an article the other day about a Harvard-trained psychiatrist who worked at the V.A. in Boston during the Vietnam war, and was "shocked" to learn that there wasn't a single book on war trauma in the library there. Today, one would hope, that situation has changed quite a bit. 

But to the point at hand...

As I read through my Twitter feed today (you can follow us @HealingPTSD on Twitter), I noticed several suicides being Tweeted by various sources. One was that of Mel Turpin, a former All-American basketball player and NBA star, dead at 49; and then the troubling news, especially to us in the veterans community, of a Marine Corps veteran, James F. Popkowski, 37, who apparently died in a "suicide-by-cop" or armed confrontation outside the V.A. in Bangor, Maine. (See those stories linked here and here, as well as a longer quasi-obituary of Popkowski, here.) At first the headline said only "an armed man" had died in a confrontation with police near a local VA -- and as soon as I read that, I hoped -- but yet somehow knew -- that it would be a veteran, with a painful story of his own. Later the news matured to show that in fact he was a veteran, who was struggling with this illness (cancer) and its treatment. But the fact he was a veteran and committed suicide reminded me instantly of the news from the last few days, where the Seattle Times did such a good job covering the suicide of a veteran with PTSD from Whidbey Island, Orrin McClellan. (I wrote about Orrin's life and death here and here.) So many suicides in the media, and superstitious types tend to think those run in threes -- though technically McClellan's death was in mid-May, with the coverage of it in the media happening over the last few days.

I need to branch off in two different directions here, to cover this material. 

One is to talk about the V.A. suicide's statements about his own condition, because veterans with PTSD and their family members may recognize their own veterans in those words. And the other is to introduce something very different, which is the effect that media coverage of suicides has on "successful" suicide attempts by others during the same general news cycle, especially young men (who are, after all, the majority of those who serve.) 

On that second point, as the military has generally speaking tried and failed to lower the suicide rate lately, I haven't seen much recognition (OK, any) of the idea that suicides are to some degree contagious. There's quite a bit of medical literature on the subject...and it's been documented in studies around the world, starting in the 1970s, that suicides reported in the news will have a demonstrated effect on increasing suicide attempts from specific populations who hear the news. Since suicide is a broad category -- many single-car or single-motorcycle accidents are also suicides -- and the military attempts periodically to crack down on motorcycle safety, etc., it would also be wise to enlarge the conversation to not only what other methods qualify as suicides, but also to take a look at how one suicide making the news can, depending on how it's portrayed, have an effect on increasing the number of other suicides that take place in the same general time frame, especially among those prone to committing suicide, because of depression and other factors. And we haven't even mentioned yet here the effect that some prescribed pharmaceutical medications can have on increasing suicidal thoughts.

(While it's somewhat unlikely that Popkowski, in Maine, was reading the Seattle Times' coverage of Orrin McClellan's death -- one, we never know; and two, in the age of the Internet, geographical barriers have disappeared and the news is instantaneous -- especially if you include other social media, like Facebook and Twitter, which can serve as additional sources of the same news. We're so much more wired now than when these studies first started being done, so we can't assume Popkowski didn't read the Seattle Times coverage, even though it's most likely that he didn't. For the sake of this argument -- because if it didn't happen with this case, it surely does with others, let's pretend that Popkowski did spend some time over the last few days reading the coverage of McClellan's suicide on the Internet.)

There's enough material to cover here that I need to go as far as I can with it now and then circle back around to it again soon. We'll introduce the science (below) but also cover what Popkowski said about his failing health, because his words will resonate with other veterans, who struggle not with cancer but with PTSD.

According to the article in the Portland, Maine Press Herald today, Popkowski, who had undergone a stem cell transplant for his cancer back in 2003 at the National Institutes of Health, struggled valiantly with the effects of the cancer and its treatment (both difficult), as well as sleep problems, depression and the like. In a letter to the editor of the magazine "New Scientist" back in 2008 he wrote,

"Suicide is like a little devil, always on my shoulder and always tempting me. Concern for the care of my three dogs after I am gone, my dogs being the only things I feel anything resembling passion for, is the only thing I think that has kept me from pulling the trigger on the loaded pistol, which rests next to my pillow."

He continued,

"The best way to describe the mental and emotional issue is that I am numb and passionless. Nothing brings joy or pleasure. I graduated magna cum laude with a (Bachelor of Science degree) in computer info systems and business management in just three years. Now, I cannot mentally focus enough to read a newspaper."

He added,

"I have lost count of the number of sleep aids NIH and my local VA have tried. Like the anti-depressants, none have worked."

And he described leaving his bunker, in terms that a veteran with PTSD would understand, only for brief forays out to re-provision with groceries and return, if his health even allowed him that. He wrote:

"For weeks at a time I will only leave my house once, and only briefly at night, to buy groceries and other supplies. Most of the time, the only time I drag myself into the shower, is when I have to go into town to buy groceries."

---

Now, we hope that no veteran ever crosses the bridge to suicide in his or her lifetime, and especially is not discouraged enough reading news of how another distressed veteran felt to contemplate it. Please use the resources at your disposal, including hotlines, buddies, and compassionate others as lifelines to not give up hope, because there IS hope, and you can get better. But for the rest of us, we need to keep pushing on with this narrative because there's something to learn here, including for decisionmakers who wonder about how better to educate about suicide prevention. This is where the element about the notoriety/publicity level of a suicide influences other at-risk populations.

To the science on this.

• Back in 1977, in the journal Science, DP Philips showed that "motor vehicle fatalities" (including "suicides by motor vehicle") increase in the time frame "just after publicized suicide stories." From the abstract: "The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents."
• In 2006, an Australian journal, Social Science Medicine, published a similar study, further demonstrating the "relationship between media reporting of suicide and actual suicide." They studied data on "4,635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. The study found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide." They concluded, "Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm."
  
• Versions of the original study were repeated over and over in the intervening years, and 30 years later, in 2007, the International Journal of Epidemiology published a study which showed "the influence of media reporting of the suicide of a celebrity on suicide rates," where a male television celebrity in Taiwan committed suicide, followed by a wave of somewhat "copy-cat" suicides among young men. (The "celebrity" element may initially confuse, but think of it this way -- it's a well-publicized suicide when it happens, which means it reaches most of the target audience. It also happens, according to other studies, when non-celebrities commit suicide. The distinguishing factor is how well publicized the suicide is/how much media attention or coverage is given to it. The more coverage, the more people know about it, including those in somewhat fragile populations.) Back to the study's results: "After controlling for seasonal variation, calendar year, temperature, humidity and unemployment rate, there was a marked increase in the number of suicides during the 4-week period after media reporting (relative risk = 1.17, 95% CI 1.04-1.31). The increase was in men (relative risk = 1.30, 95% CI 1.14-1.50) and for the individuals using the same highly lethal method (hanging) as the TV  actor did (relative risk = 1.51, 95% CI 1.25-1.83). However, the age groups in which the increase occurred were younger than the age of the celebrity. CONCLUSIONS: The extensive media reporting of the celebrity suicide was followed by an increase in suicides with a strong implication of a modelling effect. The results provide further support for the need for more restrained reporting of suicides as part of suicide prevention strategies to decrease the imitation effect."
• Also in 2007, a study was conducted in Taiwan around the fact pattern of the same television celebrity's suicide and published in the Journal of Affective Disorders. It attempted to define the "influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder," and what it found was "Among 438 depressive patients exposed to the media report, 38.8% reported an influence on subsequent suicidal behaviors, including 24 (5.5%) with a suicide attempt. The risk of such influence was highest among patients in a severe depressive state just prior to the media report (adjusted OR 7.81, 95% CI 3.28-18.59). Such influence on a subsequent suicide attempt was highest in patients with a most recent suicide attempt within one month prior to the media reports (adjusted hazard ratio 11.91, 95% CI 3.76-37.72)." The authors concluded, "This study has provided more convincing evidence suggesting negative influences of media reporting of a celebrity suicide on subsequent suicidal behaviors among depressive patients. Particular attention in terms of potential negative media influences should be paid to patients who are younger and currently depressed and have made a recent suicide attempt."
• This year (2010), another Taiwanese study took a look at suicide rates after media reporting of another celebrity suicide, this time a female singing star. Their premise was that "Suicide attempters are known to be vulnerable to the influence of media reporting of suicide events. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicide attempts and associated risk factors among suicide attempters." In their study, "Sixty-three suicide attempters registered in a surveillance system of Taipei City Suicide Prevention Center were assessed using a structured interview soon after media reporting of the suicide of a young female singing star." Their results? "Forty-three (68%) respondents had encountered with the suicide news. Among them, 37% reported being influenced by the media reporting on their subsequent suicide attempts." Most hard-hit by the news? "Men (adjusted OR 6.36, 95% CI 1.29-31.44) and younger age groups (adjusted OR 4.93, 95% CI 1.04-23.45) were more susceptible to the media reporting." And the authors concluded, "This study has provided further evidence for suicide imitation among vulnerable people encountered with media reporting of celebrity suicide, and for the need to actively restrain reporting of suicides to decrease the imitation effect."

It's also true that young men -- the dominant demographic of who the all-volunteer military is these days, though approximately 11% are women -- are more prone to suicide than other age groups. Back to the science:

• According to statistics from a fact sheet on youth and violence provided by the CDC, "In 2005, 17% of high school students seriously considered attempting suicide, and 13% made a plan about how they would attempt suicide during the 12 months preceding the survey." (The reference cited is CDC. Youth Risk Behavior Surveillance - United States, 2005.  Morbidity and Mortality Weekly Report 2006; 55 (SS-5): 1-112.)
• Similarly, according to the CDC, "approximately 14% of all deaths among children and adolescents aged 5-19 years result from suicides."  The numbers climb according to age ranges, with younger children having the fewest, and older children the most.  Suicided ages 10-14: 283.  Suicides ages 15-19: 1,700.  (The reference cited is CDC, National Center for Injury Prevention and Control, Office of Statistics and Programming. Web-based Injury Statistics Query and Reporting System (WISQARS). Online at http://www.cdc.gov/ncipc/wisqars/. Accessed September 6, 2007.)

There's more that we could talk about here -- responsible reporting guidelines about suicide, when disseminated and implemented, seem to have the effect of reducing the number of copycat suicide attempts after a successful publicized suicide (a study in Austria shows that) -- but the intended effect here, which we can elaborate on in future posts, is to introduce the idea that one publicized suicide by, say, a veteran, can also most likely encourage an increased number of suicide attempts, some of them successful, by members of at-risk populations, such as young/depressed/men. Do any of those words correlate with anyone who might be suffering from PTSD, or taking medications that might also increase suicidal thoughts? And we haven't even added into the mix the effects of alcohol, which many PTSD sufferers self-medicate with, and how that would affect suicidal thinking. There's much, much, much more to talk about on this topic -- not just here on this site but nationally -- but we hope this dense, rather convoluted post has at least gotten you thinking about not so much that we need to protect veterans with PTSD from seeing or reading the news, which might contain an item about another veteran's suicide -- but that suicides can almost go in waves (read the literature on prison populations, etc. for this), where one suicide spurs others in the same population -- because publicity surrounding a suicide has the unintended consequence of increasing suicidal tendencies in other affected people. Since many, many veterans with PTSD are to a degree on edge already...it might be good to realize the effect that reading about another veteran's demise could have on an already depressed, stressed or demoralized individual.

And since the larger goal for all of should be preventing suicides among PTSD-injured veterans, it's highly worth having this conversation.

The Healing Space between Inspiration and Destruction

As the last quote I'd like to introduce from Robert Johson, the Jungian analyst, for now, it's a passage about a type of altar seen among "primitive" peoples in Peru, who often carry this altar with them, the better to address spirituality wherever they are. I've made a botch-up of the illustration, because I wasn't able to find a "perfect" representation of the mesa, so it's a combination of several that I saw. Here is Johnson's quote. Once again, it's part of the ongoing "conversation" we're having, about whether one side has to "win out" in our natures in order to heal. Johnson and the curanderos of South America would seem to say, "no." Healing is what takes place in the space between...

 "A particularly powerful form of (overlap between darkness and light, or the self and its shadow side) can be seen in the customs of South American curanderos, who are a curious mixture of primitive shaman and Catholic priest. Their mesa (table) is an altar where they say Mass for the healing of their patients. They divide this altar into three distinct sections. The right is made up of inspiring elements such as a statue of a saint, a flower, a magic talisman; the left contains very dark and forbidding elements such as weapons, knives or other instruments of destruction. The space between these two opposing elements is a place of healing. The message is unmistakable: our own healing proceeds from that overlap of what we call good and evil, light and dark. It is not that the light element alone does the healing; the place where light and dark begin to touch is where miracles arise." -- Robert A. Johnson, Jungian analyst, author of "Owning Your Own Shadow: Understanding the Dark Side of the Psyche."

For more on the topic of the "Tao of Healing," click here. It's a selection of quotes that represents the ongoing, organic process that we undergo whenever we want to get well.

Editor's note: For more on the curanderos and their mesas, click here or here.

Quotable Quotes -- World War I British Doctor on Humane Treatment for PTSD

" Do not send your cases down the line ... when you get these emotional cases, unless they are very bad ... give him a rest at the aid post if necessary and a day or two’s sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war or look through his periscope and let the man see you are taking an interest in him, [and] you will not have nearly so many cases of anxiety neurosis." -- Col. J. S. Y. Rogers, 4/Black Watch, Report of the War Office Committee of Enquiry into 'Shell-Shock’ (London, HMSO, 1922), 64. Quoted in "'Pitiless psychology': the role of prevention in British military psychiatry in the second world war," by Ben Shepard, published in The History of Psychiatry, 1999; 10; 491, linked in full here.

Violence at Camp Liberty: Shocked, Maybe, but Not Surprised

 Allow a little venting of spleen here: The violence at Camp Liberty today in Iraq, where an American active duty servicemember allegedly opened fire on others at the stress clinic, a location where other servicemembers go for counseling, killing 5 at 2:00 p.m. local time -- if we're shocked that this happened, that's okay; but seriously, America-- why are we still "surprised"?!

Here's 10 reasons NOT to be surprised, though feel free to continue to be shocked:

1.    Tours are too long, putting considerable and unprecedented strain on the all-volunteer military. The AP reports, "The U.S. military is coping with a growing number of stress cases among soldiers in Iraq and Afghanistan - many of whom are on their third or fourth combat tours. Some studies suggest that about 15 percent of soldiers returning from Iraq suffer from some sort of emotional problems." The ones who initially deployed?  Strong and willing.  But as the tours wore on, how many stayed that way?  Certainly not everybody.
2.    Resources for stress management are inadequate, and there's often peer pressure not to make use or take advantage of them -- and then the broader question: what are we really offering to help soldiers heal?  Is there anything in the conventional medical world that's actually working? There's talk therapy and there's medication, and those who follow this topic in-depth know that there are problems with either or both of those approaches.  Anecdotally, of the three combat veterans whose lives I follow most closely, all three of whom had recently pronounced substantial healing  -- two of the three who relied on the most conventional approaches -- were re-hospitalized within the past month for psychiatric reasons, each within several weeks of pronouncing how much better they were doing, thanks to their course of treatment.  (The third combat veteran, who follows a less conventional path, is actually truly doing better -- or so it would currently seem.) When it comes to combat-based PTSD, the "cure," such as it is -- is a long way off -- particularly if we only look along conventional channels.
3.    Access to firearms is...ummm...not an issue: they're everywhere.  It's war, and we're armed to the teeth.  It's part of what we do.  But carrying a weapon in a stress clinic?  Doesn't seem on the face of it to be a wise safety choice;
4.    Workplace violence is a fact of civilian life, too: OSHA reports that homicide is the fourth leading cause of workplace fatalities. On an average workday, according to one site, "three people will be murdered on the job in the U.S."  Annually, "one million workers are assaulted, and more than 1,000 are murdered." Concerns are that half these cases go unreported, so the figures might even be doubled. Mondays, in fact -- today  when the Camp Liberty incident took place is a Monday, after all -- are a prime time for incidents to take place.  Something about people stewing about their real or imaginary mistreatment over the weekend, and coming back in and deciding to "do something about it."  Read the cases: Monday is often when disgruntled American workers, at the very least, choose to settle the score;
5.    Sleep deprivation is a chronic problem in the over-extended military.  As a technique for inducing symptoms along the spectrum from abject misery to forms of psychosis, it's effective enough that it's used (by the U.S.) as a form of torture, like waterboarding. Going without sleep, which the military chronically does, puts soldiers at risk on a regular basis.  Not that there are any easy answers to this, but that needs to be taken into account. Not sleeping is very dangerous to your health: and if to yours, by extension to those around you, too. Experts like veterans advocate Jonathan Shay, M.D., Ph.D. have long warned about the dangers of exhaustion and sleep-deprivation.  It's time to pay greater attention;
6.    Talking heads and pundits attempt to minimize the problem by saying, it's only the fifth case of soldiers killing one another since the war began but REALLY -- are they serious?!  How about adding the qualifier, "known" case -- as in, proven.  (Even the New York Times said, more accurately, "The killing of American troops by their fellow soldiers is infrequent, but not unheard of.") Think of the many cases of noncombat deaths in Iraq.  How many of these, because of insufficient, inadequate, or misguided investigations -- or cover-ups -- might turn out to be soldier upon soldier violence, if we but knew the facts? A percentage of the noncombat deaths are murders, not just accidents or suicide.
7.    Felony waivers. While many -- or most -- of the military may be fine and upstanding individuals -- better, in fact, than most of their less patriotric, more self-centered peers -- the reality is, as the war continues, an increasing few who have less savory backgrounds or mental states are being given waivers and allowed to join anyway -- then deployed with the rest of the troops, and put under the same types of strain, which perhaps they don't bear very well -- or as well as their peers;
8.    If recruiter suicides are up (and they are) -- recruiters being in a good position to know the true costs of going to war on the troops -- and suicide is effectively giving up on their being a solution to one's problems -- shouldn't  this ring some greater warning bell than it has, that perhaps we're asking people to do and to sacrifice, far beyond their actual ability to?
9.    We can't discount the fact that some people are just unbalanced -- and some of the ones who are, unavoidably, also serve in the military.  The last well-publicized statistic on the subject was that roughly 10% of the (overall) population suffers from mental illness. Some of these people are in the military, and under stresses and strains greater than most of us have ever endured, some will snap.  that in itself should not really...surprise us.  It's not a diss against the military: it's a fact of life. If anything their challenges are stronger than anyone else's.
10.  Interpersonal violence and suicide are both extreme versions of "lashing out" at what's perceived to be an unjust fate.  Domestic violence rates in the military ARE worthy of some "shock 'n awe" of their own.  During the same news cycle, where the Camp Liberty incident is being broadcast across all possible news outlets, other, equally horrendous incidents are also happening among servicemembers and veterans -- horrendous to the victims and their families, as well as to the families of those who commit the crimes. Here's an example of the same from today's news cycle, though it's all been pushed off the page by the greater prominence of the Baghdad story. The Colorado Springs Gazette reports that Thomas Woolly, 24, was arrested in the shooting death of a 19-year-old woman.  As the Gazette describes, "Woolly ... was a heavy machine gunner in the 4th Infantry Division's 2nd Battalion, 12th Infantry Regiment.  Members of the 500-soldier unit, nicknamed the Lethal Warriors, have been involved in stabbings, beatings, brawls, domestic violence, shootings, at least two attempted murders and four homicides in Colorado Springs. Another soldier who served with the unit in Iraq has been accused of murder in California. The unit has also been plagued by drug abuse and suicide..."

By bringing this up -- that this violence might be "shocking," but surely shouldn't be "surprising" -- it isn't intended to single out servicemembers or veterans as "bad" -- if anything, they're under abnormally large stressors.  It is to say, this stuff happens -- not always as well broadcast as when it happens in a group.  But it happens all the same. Forgetting even Iraq and Afghanistan for the moment -- across AMERICA -- do we honestly believe that fewer than five people -- including the servicemembers and veterans involved -- had their lives in actual, mortal danger from incidents like this? (In the Woolly incident above, for example, one woman was killed, but another one was injured, according to published reports.)

Again, if we were but able to "see" across the broad expanse of all the people this affects, and into all their homes and lives, even on one given day, I think we might be quite surprised to see the continuing emotional toll and strain that combat stress and its aftermath produces. Continuing to look at incidents like whatever happened at Camp Liberty today -- as the facts continue to come out, over time -- as "isolated" incidents, instead of a very visible part of the mostly in-visible spectrum of pain and suffering -- only allows us to stay in the dark on this topic a little longer than we should. 

For the health of servicemembers, veterans and their families, it's time to start admitting what a difficult problem we have: and one that takes more than lip service, and conventional modes of treatment, to "handle" and ultimately to "solve."

The Poetry of War: This Time, from Afghanistan

The BBC has an article today called "Afghan Poets Tackle Scars of War," linked here.

The article writes, regarding the effect the war has had on the national literature:

"This theme of violence is playing out in other genres in ...[Afghanistan], such as short stories. But it is more visible in poetry.

"It is not the poets' choice to write about war and violence, they are compelled to do so - to express their reaction and hatred to bloodshed," says Darwesh Durrani, a popular [Afghan] poet and professor of literature in Quetta."

Additionally, 

"Poets are inspired by what is happening in the outside world. Their imagination absorbs it," says veteran [Afghan] poet in Peshawar, Rahmat Shah Sael.

"That is why [Afghan] poets are writing about violence in one way or another."

One of the poems in the article is evocative of the violence and grief Afghans are experiencing.  The lines are from Zarlasht Hafeez, "a female Pashto poet who has published a collection called 'Waiting for Peace'." Her lines read:

"The sorrow and grief, these black evenings,

Eyes full of tears and times full of sadness,

These burnt hearts, the killing of youths,

These unfulfilled expectations and unmet hopes of brides,

With a hatred for war, I call time and again,

I wait for peace for the grief-stricken [Afghans]."

It's unclear whether Afghan poets are publishing books of their poetry or reading individual poems aloud, according to local tradition.  However, the feelings about war, grief and loss that they're expressing through poetry are an essential communal reaction, and will take their place alongside similar expressions from others who have experienced the pain of war.  The right hand "sidebar" of this website includes a number of books of poetry, from this war and previous ones -- whether individual books of poetry, or anthologies of war poetry. For an index of material we've written on this blog about combat and poetry, click here.

Editor's note: The photograph, of an elderly man surrounded by villagers and Aghan National Army soldiers during search operation in rural Afghanistan, 2007, is by noted humanitarian photographer Zoriah.  Used with permission.  For more of Zoriah's work, click here. 

Suicide Predictors in Young Men -- Combat Trauma Not Included

We've talked on the blog before about "suicide maps" and various predictors of suicide, however imperfect they may be.  Today there's an item from a medical journal that details a Finnish study -- aka, a medical study performed in Finland -- which essentially says, adolescent boys and young men who committed suicide frequently also showed some form of psychiatric illness at age 8 -- which happened to be the age where they were first evaluated, in the study.  Young women who killed themselves, didn't show this particular trend. Now, not to say that this study is in any way conclusive about PTSD -- since obviously it didn't even touch on that as a topic -- but it is interesting, since some of the research indicates that PTSD can be particularly difficult if it is "laid on top of" a previous, significant traumatic experience (often in childhood). In some ways, this study may not be all that germane to our topic, but it's interesting to note, in any case, since there are obviously a number of young men (and women) who commit suicide in the armed forces, and as veterans -- and it's always worthwhile to comb the scientific literature for any other reasons, or contributing factors into, why this might actually be.  Here's the info from the study:

Childhood Psychiatric Problems May Predict Suicide Attempts in Males

Most males who commit suicide or need hospital care for suicide attempts during their teen or early adult years appear to have high levels of psychiatric problems at the age of 8, according to a report in the Archives of General Psychiatry. However, later suicide attempts in females are not predicted by mental health issues at this age.
 
Andre Sourander, MD, of Turku University Hospital in Finland, and colleagues studied 5,302 Finnish individuals born in 1981. Eight years later, information about psychiatric conditions, school performance, and family demographics was gathered from children, parents, and teachers. Participants were then tracked through national registers through 2005.
 
Between the ages of 8 and 24, 40 participants died, including 24 males and 16 females. Of those, 13 males and two females died from suicide. A total of 54 males and females (1%) either completed suicide or made a suicide attempt serious enough to result in hospitalization.
 
Of the 27 males who either seriously attempted or completed suicide, 78% screened positive for psychiatric conditions at the age of 8, compared with 11% of 27 females who had serious or completed suicide attempts. In addition, males who would go on to make life-threatening or completed suicide attempts were more likely at the age of 8 to live in a family that did not consist of two biological parents, have psychological problems as reported by a teacher or have conduct, hyperactive, or emotional problems. However, none of these factors at 8 predicted later suicidal behavior in females, and depression at age 8 was not associated with suicide attempts for either sex.
 
Previous research has shown that in females, suicide is associated with depression and other affective disorders, which increase sharply after the beginning of puberty. This may explain why childhood psychiatric conditions do not predict later suicidal behavior in girls, the authors noted.
 

— Source: American Medical Association

A Look in "The Mirror" -- Great Britain Seeing War Trauma Now in 3 Years, Not 13 As Before

Because Americans are notorious for paying little attention to things that happen elsewhere, even among other English language-speaking countries, here's some news from Great Britain's tabloid-esque "The Sunday Mirror" today about their soldiers' battles with PTSD on the homefront -- soldiers who served in Iraq and Afghanistan.  For the link to the article, called "War's Silent Victims," by Rupert Hamer, click here. (The tabloid nature of the newspaper explains the fairly breathless writing style, but let's hope the facts and the reporting are accurate nonetheless.)

Points worth mentioning from the article include:

"Alarmingly, the charity [Combat Stress, see below] say[s] the figures are just the "tip of the iceberg" and add that the rate at which soldiers are developing the condition has accelerated. Usually it takes 13 years for cases of post-traumatic stress disorder to develop in veterans.

But psychiatrists at Combat Stress's pioneering centre say the men and women now being treated have come forward after just THREE years.

Also:

Dr Walter Busuttil, a consultant psychiatrist at Combat Stress, said: "What we are seeing now is just the tip of the iceberg.

"Because there has been no proper study of post-traumatic stress disorder among troops in this country we have no idea of the true scale of the problem.

"The same thing happened in the US after Vietnam. The Government tried to dismiss the disorder as a myth - then the whole thing exploded. Now when I speak to my colleagues in America they tell me: 'You are going through your Vietnam'."

And finally:

Dr Busuttil, 49, a psychiatrist in the RAF for 16 years, says the Government has covered up the severity of the conflicts from the public.

"The worst thing for a serviceman or woman is to come back from a war and for people not to have any idea what they have been through.

Editor's note: For a link to Great Britain's charity, Combat Stress, click here.  To find them on Facebook, click here. We've written about them before on this blog, but according to their website, "Combat Stress is the leading charity specialising in the care of British Veterans who have been profoundly traumatised by harrowing experiences during their Service career and who are suffering from poor mental health as a result."

Study Shows Mind-Body Medicine Works on PTSD

(Just what we've been talking about, and who we've just been talking about as well.  Heh.  Love that.  So confirming...)

Read down and see how therapeutic this would be for people in rural communities, with little or no access to the VA, who are in therapy or not, for DIY types and those who prefer to access healthcare through a practitioner of one kind or another.  Just wonderful... and we knew it all along :-)

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The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

 The CMBM approach includes self-expression and mind-body techniques and was offered to these children over 12 sessions in an educational, supportive small group setting. Eighty-two high school students in Kosovo participated in the study. The program was conducted by teachers and included meditation, guided imagery, breathing techniques, and biofeedback as well as self-expression through words, drawings, and movement. All the students met the criteria for posttraumatic stress disorder (PTSD) which was measured using the Harvard Trauma Questionnaire. Following the program, the number of students having symptoms indicating PTSD was significantly reduced from 100% to 18%. The reduction in symptoms was maintained at a 3 month follow-up. The improvement in PTSD symptoms was significantly greater compared to a similar group of students who did not participate in the mind-body skills program. This is the same model that CMBM’s founder and director, James S. Gordon, M.D., describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have, and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

For more information about the upcoming training, click here,  or to order Unstuck: Your Guide to the Seven-Stage Journey Out of Depression", please email The Center for Mind-Body Medicine (CMBM) at [email protected] or visit www.cmbm.org.

Find the Cost of Freedom, Buried in the Ground

It's an old Crosby, Stills & Nash song, by Steven Stills. Many of us who were there in the 70s still remember the words. I know I can recite them from memory: "Find the cost of freedom, buried in the ground. Mother Earth will swallow you; lay your burdens down."

Tomorrow is the Fourth of July.  Not only my favorite holiday the whole year through -- sorry, I'm a New Englander, we're just born that way -- but also another opportunity - along with Memorial Day, and Veterans Day - to stop and honor the service of those who sacrificed their lives for freedom, or at least, responded to what they saw as the call of duty that they responded to, while others did not. Those whose blood was shed on American soil -- in Lexington, Massachusetts, in the Revolutionary War -- and also, more recently, in the jungles of Vietnam, in the mountains of Afghanistan and in the sands and urban jungles of Iraq.

I'm thinking today about censorship -- and the power of an image to convey, in a single instance, what those of us who labor over our words perhaps never can.  The picture, they claim, is worth 1,000 words -- perhaps because it communicates, in an instant, across barriers of language, space and time -- what human beings instinctively understand, nonverbally.  With war: that there is a price; that it is never really glorious; that those who give their lives often do so -- as the poet W.H. Auden wrote about the famous art masterpiece, the "Fall of Icarus," by the Dutch painter, Brueghel -- in a depressingly inglorious context:

"About suffering they were never wrong,

The Old Masters; how well they understood

Its human position; how it takes place

While someone else is eating or opening a window or just walking dully along...

If you don't remember the Greek myth of Icarus you might need some refreshing.  He's the pre-Wright Brothers son of Daedalus, whose father built him a pair of wings, in order to take flight and escape from the island of Crete.  But the father glued the wing feathers in with wax, and then warned his son not to fly too close to the sun (probably without explaining actually why.)  Icarus partially succeeded in his goal -- he was able to fly, but in flying, did get too close to the sun -- at which point the sun's rays melted the wing feathers' wax and he literally dropped out of the sky, into the ocean -- having succeeded in his fabulous quest and also painfully failed, all at the same time.  That's not the parallel with the armed forces: the parallel worth drawing here is that sometimes death on a glorious "mission" turns out to be a most pedestrian thing, and the rest of us, unless we're apprised of it, don't even notice or celebrate.  On a deeper level, it brings up the question: as Americans, how exactly do we "support the troops," if we're not even really aware of what they're up against?

Unlike Vietnam, where grainy black and white news footage of U.S. soldiers fighting and dying in foreign jungles was often watched during dinner, with Walter Cronkite narrating -- in Iraq and Afghanistan, we're reduced to very little coverage and certainly not much that could "upset" our "overly tender sensibilities."  No flag-draped coffins being offloaded at Dover Air Force Base, instantly communicating that for every loss in combat there's a grieving, distraught family and a hole in the community, left by that veteran, that will never be filled.  Even those, like me, who don't exactly excel at math -- we're more than dimly aware that for every servicemember KIA -- or killed in action -- there are scores more wounded and disfigured for life -- emotionally scarred (invisibly) as well as visibly.  The human costs are staggering: those are daddies and mommies, sons and daughters, brothers and sisters, employees and employers who come home different: maybe unable to work, maybe unable to function - initially or long-term; maybe unable to take care of their families while they struggle with their own wounds of war.  This is the human cost of war: it exists whether we are personally dialed in to it and aware of it, or not.  It is, to use the words of Hedley Peach, a "generic effect of combat."

And while the news media gives scant coverage to what is happening in the conflicts in Afghanistan and Iraq, as surely as the hands of our clock tick daily the minutes and the hours, somebody's sons, daughters, brothers, sisters, fathers, and mothers are dying, and being injured -- somewhere.  We can be for or against the wars -- forget that noise for now -- but at the very least, we ought to be for the veterans.  And their families.  If what happens is fully what they signed up for: so be it.  I'll say this for myself, if no one else: They're better people than I am.  If it's not what they bargained for: even more reason to feel compassion for what they're going through.  But here's a pretty elementary principle: if we don't see it, we can't grasp it -- and we move on with our lives as though nothing were really happening.  No coffins at Dover? No bodies on the news?  I guess this war isn't really costing that much in human terms after all...it's just another blip on our radar, hardly making a difference among the rest of the pronounced concerns of our lives and welfare.  Except that it IS happening -- and men and women are dying, and being injured, often grievously -- and we're, generally speaking, like the villagers in the Icarus poem, above (read the whole thing) pretty unaware of how that affects us, or if it even does.

And THAT is where journalism comes in, and photojournalism -- to convey in a single image, what dozens of column inches can barely touch.  A single image that resourcefully, potently conveys the reality of life and death on the knife edge, on the tip of the spear -- somewhere around the globe, and challenges you, me, us -- the viewer -- to say that it matters, and that we finally understand.

Maybe that's why in every craptastic Third World-ish revolution, they always kill -- um, that would be the military who does the killing -- the intelligentsia -- the artists, the poets, the thinkers, the intellectuals -- first.  Because I guess if you even goad the populace at large to think, why, you're a highly dangerous individual, and should be stopped -- before you can do any more harm (I mean, good.)

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Want a riveting image, that "stops the presses," and conveys for all time the intrinsic truth -- or at least, one powerful truth -- about an experience?  Turn to a photojournalist.  I've read more words than I can think of in my time, but if you want to know what I remember -- it's the images, often Pulitzer Prize-winning, from the eras of our shared experience.  Vietnam? It's the naked young girl, covered in Napalm, running from her burning village.  (We dropped the Napalm, btw...) Famine in Africa?  It's the buzzard, waiting for the tiny dark baby with its protruding ribs to just "hurry up and die, wouldja?!" so the buzzard could eat it.  (The photographer who shot that amazing scene, and won a Pulitzer Prize for it, later killed himself -- perhaps because those who witness tremendous suffering, also suffer tremendously themselves.)

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I'm not going to say who it is, because -- call me a fatalist -- I don't want to wake up tomorrow and find out that he's dead.  ESPECIALLY not on the Fourth of July -- that would be offensive in the extreme.  But the other day, some well-known and ridiculously good photojournalist blogrolled me -- stuck a link to this blog on his blog -- and I checked it out, to see what his stuff was like -- and of course it was riveting.  He's an embedded photojournalist in Iraq, or was, I should say, until the Marine brass apparently got fed up with him, and summarily pulled him out of his embedded assignment and out of the country.  His only offense, from the sounds of things?  Shooting the aftermath of a suicide blast in Ramadi -- you know, the Anbar province -- the Sunni triangle -- the previous hotbed of violence in Iraq -- which if we're to read the mainstream media, why, all that has calmed down considerably from a few years ago, and there's hardly anything brewing there at all.  Well, except for the lives of scores of people who died there, INCLUDING MARINES, in a suicide bombing just last week.  This guy documented it -- as sensitively as one could, given the horrific nature of the scene -- and he expressed the emotional toll it was taking on him, as no other experience had.  And somebody in the Marine Corps upper echelons took offense at what the rest of us call -- oh, I don't know -- the First Amendment -- and took steps to pull him out of there, on the double.

Let's HOPE the guy lives long enough to evacuate safely.  Really.  And then let's hope he still gets to show what he shot, at great personal cost -- because some of the rest of us (it's a refresher course: we're called Americans) want to actually SEE the cost of freedom -- in a way that those of us who don't serve, don't know; and those of us who do, and did -- know only too well.  It's only fair.  If we sanitize the living daylights out of these wars -- for what? -- not only will the American public not "get" the tremendous price paid by those serving AND their families; they won't be as compassionate to the same people afterwards as they need to be.  It's in all of our best interests to actively fight for, and preserve, the freedom of the press.  And that means photojournalists, who document war's horror, sufferings, and triumphs in a way no print journalist could ever begin to approximate.

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For my part, when I saw the photos in question the other day, I had myself a good, therapeutic, and instantaneous cry -- not just for the crumpled bodies of THOSE Marines on the ground -- he was subtle, nuanced and concerned enough not to show their faces, or anything else that identified them -- but for all the others I knew and knew about, who'd fought, been injured, or died there -- or returned home, not quite as intact, in body or soul, as when they'd left.  To deny us, as Americans, the chance through images like this to share the plight of those who are fighting on our behalf elsewhere in the world, is to deny us the chance to share what servicemembers are going through; and to deny them the chance to know that somewhere out there are people who "get," admire and respect the tremendous price they've paid through their service.

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The Marine Corps, which wants to sign more patriotic young sons and daughters up to fight, apparently thinks that by constraining the version of what reality is to just a portion of the whole will keep them happy and us in the dark, and people like this brave guy, the photographer, well, in complete limbo.  Little do they know that the patriots will still fight, but the rest of us could use an education course in compassion, sensitivity and yes, tenderness for those who've fought in battle, that only comes through expanding our horizons, and by facing the whole truth of what they're really going through, as combatants. Don't sugar coat the truth: everyone who goes to war comes back changed -- that's just how it is.  Let's develop a compassion and an understanding for what they go through, not sweep it under the rug.  The death and injury of those with whom they serve is often the most scarring aspect of combat there is.  Just ask those who've never been the same since.

So especially on this Fourth of July, as one extraordinarily talented photojournalist sits in limbo, let's hope still alive, ripped out of the fight for no other reason than that he was getting a little too close to home in showing us what war is really like -- I'm appalled to think that as Americans, we're not being trusted with the whole truth, when it's expressly the whole truth that we need, as Martin Luther King once said, to set us free.  We need to know the human costs of these battles we're in.  And suppressing the images of that just harms our servicemembers and their families, and cripples the compassion of us as a people.

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Until I looked it up just now, I didn't realize that Crosby, Stills and Nash song had other lyrics.  Apparently it does.  Besides the chorus (above), which I remember so well, there's another verse as well:

Daylight again, following me to bed
I think about a hundred years ago, how my fathers bled
I think I see a valley, covered with bones in blue
All the brave soldiers that cannot get older been askin' after you
Hear the past a callin', from Armegeddon's side
When everyone's talkin' and no one is listenin', how can we
decide?

On the behalf of all those "brave soldiers that cannot get older," could we at least not suppress and crush the efforts of those who are trying to get us to see the whole truth?  What truth is that, you may ask?  The very cost of freedom, buried in the ground -- in Iraq, in Afghanistan, and in Vietnam beforehand. Godspeed, Z.  You are a witness on ALL of our behalf, to the price that war really exacts, on those who serve in it.

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

Professor Hedley G. Peach (Australia)

BSc(Hons) (Wales), MBBCh (Wales) PhD(London), FFPH(UK)
University of Melbourne

(Retired) Professor, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, AUSTRALIA.

Professor Hedley Peach is a Visiting Consultant at the Ballarat Base Hospital, and Professional Fellow at the University of Melbourne.

Professor Hedley Peach qualified as a doctor in Wales where he became interested in the social causes of illness. This interest led him to train in community medicine at the renowned St. Thomas's Hospital in London where he worked for seven years as a lecturer/senior lecturer. In 1985 he migrated to Australia where he was Foundation Professor of Tropical Health at James Cook University for three years and, subsequently, Professor of Community Medicine at Melbourne University for fourteen years. He retired earlier this year but continues as an honorary Professorial Fellow of Melbourne University. He has been interested in the nexus between religion, spirituality and health for a number of years. In 2002, he wrote the first article on this topic to appear in the Medical Journal of Australia to stimulate debate on how the medical profession should respond to research and recommendations from the USA. He has authored book chapters and papers on spirituality and women's health, the religions of rural Australians, and other topics. He has given many radio and newspaper interviews on spirituality and health. He is the author of several books, including The Epidemiology of Common Diseases and Disablement in the Community, as well as the leading author of more than 100 articles in scientific journals. He is a member of the National Heart Foundation's expert group on psychosocial causes of heart disease.

Dr. Ecstasy Will See You Now

An article in yesterday's Sunday Times (London, UK) talks about the drug, Ecstasy, as having therapeutic potential for treating severe, unremitting PTSD.  The article, which is titled "Ecstasy is the Key to Treating PTSD," by Amy Turner, is linked here.  The drug in question is more properly known as MDMA, or 3,4-methylenedioxy-N-methylamphetamine, pictured here.

The article says that MDMA's potential therapeutically wasn't noticed until 1976, "when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, “an easily controlled altered state of consciousness with emotional and sensual overtones”, could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was “empirical” in the scientific sense – no placebos, no follow-up testing – but anecdotally the results were almost entirely positive."

The therapeutic potential for treating PTSD is apparently to be found, according to the article, "in the trust it establishes."  One researcher familiar with the drug, quoted in the article, states:

“Many people with PTSD have a great deal of trouble trusting anybody, especially if they’ve been betrayed by someone who abused their trust, like a parent or a caregiver,” he says. “MDMA has this effect of lowering fear and defenses. It also allows more compassion for oneself and for others. People can revisit the trauma, feel the original feelings but not be retraumatized, not feel overwhelmed or have to numb out to cope with it.”

This is obviously good news for PTSD sufferers.  The study is still in its early phases, and the reality is, that if PTSD is able to be treated with one or just a few doses of MDMA, versus potentially years of psychotherapy and/or lengthy courses of pharmaceutical antidepressants, etc., this news is likely to be welcomed more warmly by patients eager to get well than by healthcare providers who previously expected to be providing maintenance doses of psychotherapy and/or pharmaceutical care for years to come.

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The formal study analyzing MDMA's therapeutic effects on PSTD is being conduced by Michael and Annie Mithoefer, under the auspices of MAPS, the Multidisciplinary Association for Psychedelic Studies, linked here.  While this might sound like a highly "hippy dippy" research project, the reality is, the other day I called a research group at the University of Arizona's Department of Psychiatry, and listened to a recorded message about a trial of psilocybin and OCD.  (See article, linked here.)  Mainstream medicine is apparently, if only slightly, open to studying the therapeutic uses of controlled substances.  In the meantime it's important to note that the street drug, Ecstasy, which may or may not be based on MDMA, depending on the purity, is not a substitute for taking part in a clinical trial like the Mithoefers', and there is always considerable risk in attempting to self-medicate any serious health condition, especially with illicit drugs.  Read the Sunday Times article, linked here -- it's quite informative.  And keep track of this ongoing research, which looks promising for some sufferers.

Editor's Note: In a feeble attempt at true-to-life humor, this was the license plate I saw recently on a very nice, late model Acura, parked in the driveway at a state veteran's home.  Perhaps it was just a visiting DJ.

Words of Wisdom for Veterans from Down Under

The Vietnam Veterans Association of Australia -- whose excellent motto, "Honour Those Who Died, But Fight Like Hell for the Living," we strongly agree with -- is a good source of information on the Australian government studies on the health of Vietnam veterans and their families.  These are important studies for any number of reasons, but for our purposes, because they make the point that combat trauma affects not just the veteran but also his or her family, and transfers effects into the next generation.  Their extensive information about the original Australian study, first published in 1998, is linked here.  They comment: "The responses themselves tend to support the hypothesis that the health status of the veteran has an effect on the health status of his immediate family."

Here are some specifics: "36% of veterans report that service in Vietnam, or health problems arising as a consequence of their service in Vietnam, have had a serious adverse effect on current or past partners.  Some 40% report physical or psychological health problems in their partners that they feel may be related to the veterans' Vietnam service.  Stress (40%), anxiety (34%), and depression in partners are the most commonly cited conditions.  Thirty nine percent (39%) of all veterans with partners report that treatment has been required for these conditions.  Those with greater length of service in Vietnam report higher levels of problems."

Though they noted that "the report notes difficulties that may have affected the accuracy of reporting and the accuracy of the comparison data" regarding the children of veterans, they found that settling those difficulties and verifying the results was an urgent matter, because the study concluded that, besides physical consequences to veterans' children (e.g., birth defects, etc.), that "deaths from suicide of children were reported at three times the expected rate, and deaths from accident or other causes were reported at twice the expected rate."

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The Australian Broadcasting Corporation did a news segment on "The 7:30 Report" on June 1, 2006, about these studies, called "Veterans Fear War's Impact on New Generations."  The main reporter was Natasha Johnson, and a key interviewee was Melbourne University professor Hedley Peach, an Australian public health researcher, and adviser to their government's Department of Veterans Affairs, who had spent two years evaluating the study.  Professor Peach remarked, "there's absolutely no doubt that the effects of war [are] not going to be confined just to the person who went to war."  The Australian study showed "significant mental illness among veterans also showed their children had a high rate of accidental death and a suicide rate three times that of their peers in the general community."  The problem with studies, Peach pointed out, is if they serve to simply describe the problem accurately.  It's the government who should "develop strategies in the meantime to promote resilience and break the cycle of mental illness."  The interesting transcript of that short program is linked here.  One result of the studies is that the Australian government has made counseling services available to all veterans and their families. The U.S. House Veteran Affairs subcommittee on health is contemplating expanding veterans' mental health care to families as well.  Read more about the Australian counseling decision in the PDF linked here.

British Soldiers Journey Back to Confront Ghosts from Combat Past

Because a percentage of our readership comes from abroad, and because the topic we cover is relevant internationally, today we note that the British press reported yesterday in two different articles how veteran combatants from the Falklands conflict are journeying back to confront the ghosts of their combat experience.  The Scotsman (Scotland) and the Guardian (England) both have articles on the subject, with much shared content between the two. 

The award-winning Guardian, consistently a great source of news and perspective, notes that "Two hundred and fifty Falklands war veterans - many still suffering psychological trauma from the conflict - will return to the islands this week. Their arrival and tour around local battlefields is timed to coincide with the 25th annual Remembrance Day Service [the British version of our Veteran's Day] since the 1982 Argentinian invasion." Furthermore, "among the former servicemen and women flying out are a group diagnosed with post-traumatic stress disorder (PTSD) who are hoping to exorcise the ghosts of the past."

The excellent Guardian also has new video they've created to honor the 25th anniversary of the war -- "watch the soldiers who were there relive their experiences and follow the war as it unfolded" -- and, if you're a history buff or just blank on what the Falklands War was all about, there's WIkipedia and this interactive guide on the Guardian's own site to clear up the confusion.

The Scotsman adds detail as well:

"SEVENTY former servicemen still battling with the psychological trauma of fighting in the Falklands War will fly to the islands today to face the ghosts of 25 years ago. The men, suffering post-traumatic stress disorder (PTSD), are among a group of 250 veterans from the 1982 conflict taking part in an anniversary pilgrimage to the battlefields in the South Atlantic.

For most of the men on the heavily over-subscribed [meaning, far more people signed up than were actually able to go] visit it will be their first time back since the British victory over Argentina.  The islanders - the population is less than 3,000 - are throwing open the doors to accommodate the party, including 15 relatives of those who died in the conflict, in their homes.  Organizers of the visit said that many local people have taken a week off work and offered their services as drivers for the party. One has even put a plane at their disposal to take them to outlying islands where they fought.

The event is being organized jointly by the main Falklands veterans body the South Atlantic Medal Association, and Combat Stress, the charity that works with ex-servicemen and women who are suffering psychological disabilities.  Combat Stress is providing around ten trained clinical support staff.

As well as those suffering PTSD many making the visit suffered major physical injuries such as losing limbs. Colonel Mike Bowles (retired), the chairman of the organizers, said: "Some of these guys did go through horrific experiences and saw horrific things. "I think going back and being able to be in a place and think about it and sit and maybe have some people around you, does help people come to terms with it."

But Col Bowles said the trip was also about seeing how the islands that they fought to liberate are thriving in 2007, and meeting the islanders themselves.  A total of 255 British servicemen and more than 600 Argentineans were killed in the war which ended the 74-day occupation of the islands.

Editor's Notes: (Highly miscellaneous.)  We've written about Combat Stress before.  See hyperlink.  It's the British variant on our term, combat trauma.  It's also the name of a service organization for combat veterans who suffer from PTSD in England. 

On a more serious note, notice how this event is happening 25 years after the conflict.  There seems to be a gigantic, painful lag in experiencing symptoms and confronting the past -- perhaps because of how painful it is, or how deeply the memories are buried.  This is consistent with our Vietnam veterans making trips back to Vietnam in recent years to confront the ghosts of their pasts there, and with decorated war heroes from that conflict, such as Max Cleland, who for many years headed the VA, taking 20+ years to realize that he was suffering from combat trauma himself.  In other words, it's likely to be a long, hard wait for veterans from Iraq and Afghanistan to be able to confront these experiences themselves, though we hope through many related efforts the cycle time is much shorter, for their sake. 

As Maxine Hong Kingston told me when I asked her how quickly vets were interested in writing (even for themselves) about what they'd gone through, she said that in her experience it had taken 20 years to come forward.  Perhaps that time from now on can be shorter -- but I think it underscores the gravity of the experience, and what these veterans have suffered, that it generally speaking takes that long.  Ouch.  Let's have as a goal, trying to close that particular loop, gracefully and graciously, with current veterans in a whole lot less time.

Alcohol Abuse as Self-Medication for Stress

The British journal, Public Health News, which has gone out of business(!) since this article was published, last year had a good article by Shannon McKenzie entitled, "Self-Medication through Alcohol May Leave Millions More Vulnerable."  Because we've been talking lately in this blog about how veterans (and others) sometimes can turn to substance abuse as a way to deal with enormous life stressors, such as combat trauma and/or PTSD, we though this article was worth citing.  It was written to a British audience, and does not address combat specifically. It does, however, make the point that society is increasingly turning to numbing as a way of coping.  Unfortunately, as the article indicates, it's not a strategy that works well enough, long enough; and it can ultimately backfire.  Here's what it had to say.  It shouldn't be hard to make the mental leap to the problem of veterans self-medicating for symptoms of PTSD.

Millions of UK adults are using alcohol to deal with stress, anxiety and depression, according to a new report by the Mental Health Foundation ("MHF"). But their efforts to self-medicate could in fact increase their vulnerability to more serious mental health problems.

A National Opinion Poll survey carried out for the MHF showed 48 per cent of respondents aged 35- to 44-years-old said alcohol made them feel less anxious, while 26 per cent of all those questioned reported alcohol made them feel less depressed.

The MHF report – Cheers? – notes that alcohol consumption has doubled over the past 50 years.

Alcohol, it appears, is one of the British public’s favourite coping mechanisms. MHF chief executive Dr Andrew McCulloch said drinking alcohol seemed to be a common response to problems, and this was a cause for concern.

‘The research confirms our worries that people are drinking to cope with emotions and situations they can’t otherwise manage to deal with – feelings of anxiety or depression,’ Dr McCulloch said. ‘Drinking alcohol is a very common and accepted way of coping.’

The report outlines two major problems with such a coping mechanism. Firstly, self-medicating with alcohol can become self-perpetuating. Underlying anxiety can lead to increased alcohol use, which can in turn alter the chemistry of the brain, making people even more anxious and in need of even more alcohol to ‘numb’ their anxieties. Over time this can result in individuals becoming tolerant of alcohol.

Secondly, the report states it is difficult to maintain the right amount of alcohol needed to reduce negative feelings. And, given alcohol is a depressant, feelings of anxiety and depression may rapidly return. Even worse, these negative feelings can be amplified. The report notes that as many as 65 per cent of all suicides have been linked to excessive drinking, and 70 per cent of men who kill themselves have alcohol in their system.

People with psychiatric disorders are also more likely to turn to alcohol to self-medicate.

The coexistence of alcohol and severe mental ill health problems is well-known – the prevalence of alcohol dependence among those with psychiatric disorders is estimated at twice that of the general population. People with severe and enduring mental illnesses, such as schizophrenia, are at least three times more likely to be alcohol dependent. 

Related Links:

The British Mental Health Foundation; and we would add, for our British readers, Combat Stress UK, the "Ex-Services Mental Welfare Society," which has a section of its website devoted to PTSD.  Click here for that link.

British Soldier Wins Award for Speaking Frankly about Combat Trauma / PTSD

There's a fantastic article in the British paper, the Guardian, today entitled, "You Can Teach a Man to Kill, but Not to See Dying," by Mark Gould.  (The Guardian, for those who don't know it, is a superb newspaper that frequently wins awards for its design and content, including the National Newspaper of the Year, given by the British press association.)  This article is about an ex-soldier who served in the Falklands War, winning a national mental health award for speaking "frankly and forcefully on the mental distress of war veterans."  You can listen to him talk about combat trauma (called "combat stress" in the UK) in the audio clip here, but be sure to come back and read the article as well -- it's wonderfully written and full of great, quotable quotes from the ex-soldier himself.

The award-winning ex-soldier, Chris Duggan, a Welshman, is remarkably forthright about his experience - what caused it, how far down he spiralled, and what eventually helped pull him back out.  At least in America we've given very little consideration to wars like the Falklands conflict, and even the more recent Gulf War, in which we participated, when it comes to combat trauma.  There's an overall sense that if the conflict didn't go on "that" long, how bad could the experience have been?  Perhaps especially when contrasted with wars that dragged on for years.  However, depending on what the combatants experienced, their pain and suffering is equally raw.  Duggan does a superb job of telling the truth about his own experience, and it's great to see the work won an award.  He also mentions, positively, the group "Combat Stress," which provides assistance to soldiers in the UK who've experienced combat trauma or PTSD.  We blogged about them earlier, in March of 2006.  Click here for that blog entry.

Duggan is refreshingly blunt and candid about his experiences, which is part of what makes it so worth listening to.  And he has some unforgettably graphic quotes -- deservedly so -- about combat trauma and its effects on the human mind and body.  Three cheers to Duggan and the British mental health awards for responding so positively to truth-telling from a veteran. 

Hidden Scars and Shaking Off the Black Dog

An article from the island of Wales describes one British combat veteran's healing from long-ago military trauma that's come about as he's worked on a documentary for the BBC called "Hidden Scars".  In the article, Falklands veteran Simon Weston talks about the effort it's taken him to "shake off the black dog," what he calls his own personal battle with PTSD.  As Weston says, sometimes PTSD "can show itself in the lack of a good sleeping pattern or drinking huge volumes and becoming irrational. You can become totally unreasonable, but it's just a normal reaction to something very abnormal."

Says Weston, "The authorities are very good at looking after the physical well-being of former service people, but far less sensitive to their psychological needs."

Coping with Trauma: Personal Self-Care

Another great, simple and profound article (short, too) from the Israeli site, this one on coping with trauma and practicing self care.  The link is here.

A capsulization of the advice?

1. Ask yourself if you need professional help;
2. Speak to family and friends;
3. Become experts in trauma;.
4. Maintain a healthy lifestyle;
5. Practice relaxation exercises;
6. Avoid self-judgment; and
7. Try to avoid making important decisions --at least in the days immediately following your return.

Read the whole article, though; it's great and very refreshingly, simply said.

Coping with Terror: Your Personal Survival Kit

Here is a link to a good (Israeli) site on the Web with specific advice for coping with terror, in a lovely resource article entitled, quite practically, "Coping with Terror: Your Personal Survival Kit."  The advice is low-key and reasonable, and apolitical; so potentially quite helpful.  We'll include a few highlights from the article below -- but be sure to check out the link to read the article in full.  There's also a companion article about talking to children about coping with terror.

They write:

"Ongoing international terror presents all of us with many challenges. Stress, anxiety, short temper and tiredness are common conditions in such a stressful situation. We may feel as though our reservoir of strength is being drained, and this may affect us at our studies, at work and at home. The purpose of this page is to provide you with tools for dealing with this very stressful situation successfully. Obviously these tools cannot change the political reality, but they can change your personal reality and help you get through the threat of terror, or other major stressors, safely. These tools are aimed at helping you become calmer, healthier and stronger."

The tools they highlight (and again, read the whole article, which develops each in more depth than is possible here) are:

• Stick to daily routine;
• Make sure you have a healthy diet, physical exercise and enough sleep;
• Practice relaxation daily;
• Talk about your emotions with the people who are important to you;
• Help others;
• Devote time to a hobby;
• Become an expert;

British Combat Stress Relief

An article published in a British newspaper today, entitled, "I'm Still Haunted by Pub Bombing," details the struggle of a British Army medic who witnessed, and then pitched in to help out with the victims from, a pub bombing by the IRA many years ago.  He tells the story that he lived for years without being aware of the effects of PTSD, which today he knows he suffers from.  The article is a human interest story which makes the point about how weak the PTSD available care is for veterans in England, such as this man; but it also points out the charitable work by an organization known as Combat Stress, whose website is linked here.

One of the more interesting comments in the article was this, by Robert Marsh, the director of fundraising at Combat Stress (UK): “A new report from the States has shown that 35 per cent of people coming back from Iraq are needing some form of psychological care, so it is a big problem. In the military there is a culture of self-help rather than talking about issues in the open, but I think this is changing. The military has a duty of care, both physically and mentally, for its veterans. However, there is not enough awareness about the mental problems that are caused.”

Salient points to consider are these:  Combat trauma is a worldwide problem.  The UK has experienced its own with the IRA bombings over the years, as well as participation in foreign wars, such as Iraq, presently.  People can experience PTSD symptoms many years after the fact.  Treatment is not always what it could be.  And there's the need for the military, both in the UK and here in the US, to adapt from "self-help" to greater openness about these issues.  It's also great to conceive of the military understanding it does have a duty of care that extends past deployment for its servicemembers and their families.